DEPARTMENT OF COMMUNITY

MEDICINE
MGM MEDICAL COLLEGE, INDORE
CME WORKSHOP 2010-11

Study of Effects of Caffeine

Addiction on BPO Employees

Submitted to- Submitted

by-
Dr. Sanjay Dixit Brijmohan Sahu
Professor and Head Harshit Gehlot
Department of Community Medicine, Harshul Patidar
MGM Medical College, Indore. Humaeel Abbas Ali
 DEPARTMENT OF COMMUNITY
MEDICINE
MGM MEDICAL COLLEGE
INDORE

CERTIFICATE

This is to certify that the research project entitled “Study of

Effects of Caffeine Addiction on BPO Employees” has been
successfully carried out under the Department of
Community Medicine as a project under Orientation
Workshop on Research Designing in Community Medicine.
The project was carried out by
Brijmohan Sahu
Harshit Gehlot
Harshul Patidar
Humaeel Abbas Ali

The work has been executed with due care and precision and
my entire satisfaction.

Dr. Sanjay Dixit Date:

Professor and Head
Department of Community Medicine,
MGM Medical College, Indore.
 DEPARTMENT OF COMMUNITY
MEDICINE
MGM MEDICAL COLLEGE
INDORE

CERTIFICATE

This is to certify that the research project entitled “Study of

Effects of Caffeine Addiction on BPO Employees” has been
successfully carried out under the Department of
Community Medicine as a project under Orientation
Workshop on Research Designing in Community Medicine.
The project was carried out by
Brijmohan Sahu
Harshit Gehlot
Harshul Patidar
Humaeel Abbas Ali

The work has been executed with due care and precision and
my entire satisfaction.

Dr. Bhagwan Waskel Date:

Facilitator [CME Workshop]
Assistant Professor
Department of Community Medicine,
MGM Medical College, Indore.
 DEPARTMENT OF COMMUNITY
MEDICINE
MGM MEDICAL COLLEGE
INDORE

CERTIFICATE

This is to certify that the research project entitled “Study of

Effects of Caffeine Addiction on BPO Employees” has been
successfully carried out under the Department of
Community Medicine as a project under Orientation
Workshop on Research Designing in Community Medicine.
The project was carried out by
Brijmohan Sahu
Harshit Gehlot
Harshul Patidar
Humaeel Abbas Ali

The work has been executed with due care and precision and
my entire satisfaction.

Dr. Harish Shukla Date:

Facilitator [CME Workshop]
Department of Community Medicine,
MGM Medical College, Indore.
 DEPARTMENT OF COMMUNITY
MEDICINE
MGM MEDICAL COLLEGE
INDORE

CERTIFICATE

This is to certify that the research project entitled “Study of

Effects of Caffeine Addiction on BPO Employees” has been
successfully carried out under the Department of
Community Medicine as a project under Orientation
Workshop on Research Designing in Community Medicine.
The project was carried out by
Brijmohan Sahu
Harshit Gehlot
Harshul Patidar
Humaeel Abbas Ali

The work has been executed with due care and precision and
my entire satisfaction.

Dr. Satish Saroshe Date:

Facilitator [CME Workshop]
Department of Community Medicine,
MGM Medical College, Indore.
 ACKNOWLEDGEMENT
Expressing gratitude is a difficult task, and words often fall short
of reflecting one’s feeling. It is our proud privilege, however to do
so and we undertake this task with utmost sincerity. We are
grateful to Dr. Sanjay Dixit sir, Professor and Head of the
Department of Community Medicine, MGM Medical College, Indore
for assigning this project under the Continued Medical Education
Workshop [CME Workshop] for his invaluable guidance, significant
suggestion and help accomplishing the project work.

We express our heartfelt thanks to Dr. Bhagwan Waskel Sir, for

providing us with an opportunity to do this project and giving
invaluable encouragement in our endeavors. We also thank Dr.
Deepa Raghunath Ma’am for her expert guidance.

We acknowledge with sincerity and deep sense of gratitude, the

invaluable guidance given to us by Dr. Harish Shukla and Dr.
Satish Saroshe Sir. Their suggestions and discussions were
enlightening and constant source of inspiration during our project
work. We are indebted to him for sparing valuable time for helping
us in acquiring knowledge of current approaches.

Finally we thank the BPO employees of Teleperformance and First

Source for cooperating with us. Without the help of all of them,
this project could not have materialized.

THANK YOU

Brijmohan Sahu Date:

Harshit Gehlot

Harshul Patidar

Humaeel Abbas Ali

 CONTENTS
• Introduction 7-
13
• Review of Literature 14

• Research Question 15

• Objectives 16

• Method and Materials 17

• Implementation 18

• Scoring Criteria 19-20

• Observations and Interpretation 21-

33
• Evaluation and Analysis 34-38

• Conclusion 39

• Discussion 40

• Recommendations 41

• Bibliography 42

• Appendix 43-49

I. Time Line Chart

II. Questionnaire
III.Master Table
 INTRODUCTION
Caffeine is a natural
component of
chocolate, coffee and
tea, and is used as an
added energy boost in
most colas and
energy drinks. It’s also
found in diet pills and
some over-the-
counter pain relievers
and medicines.
Caffeine is the most commonly consumed psychoactive drug in
the entire world.

Medically, caffeine is useful as a cardiac stimulant and also as a

mild diuretic - it increases urine production. Recreationally, it is
used to provide a "boost of energy" or a feeling of heightened
alertness. College students often use it to stay awake while
cramming for finals and drivers use it to push through to their
destination. Many people feel as though they "cannot function"
in the morning without a cup of coffee to provide caffeine and
the boost it gives them.

In doses of 100-200 mg. caffeine can increase alertness, relieve

drowsiness and improve thinking. At doses of 250-700 mg/day,
caffeine can cause anxiety, nervousness, hypertension, and
insomnia. It can curiously enough make it more difficult to lose
weight because it stimulates insulin secretion, which reduces
serum glucose, which increases hunger.

It's important to know that caffeine is an addictive drug. Among

its many actions, it operates using the same mechanisms that
amphetamines, cocaine, and heroin use to stimulate the brain.
Relatively speaking, caffeine's effects are milder than
amphetamines, cocaine and heroin, but it is manipulating the
same channels in the brain, and that is one of the things that
give caffeine its addictive qualities. If you feel like you cannot
function without it and must consume it every day, then you
may be addicted to caffeine.

Caffeine and Adenosine

Adenosine is found in every part of the body, but it has special

functions in the brain. As adenosine is created in the brain, it
binds to adenosine receptors. The binding of adenosine causes
drowsiness by slowing down nerve cell activity. In the brain,
adenosine binding also causes blood vessels to dilate, most
likely to let more oxygen in during sleep.

Caffeine readily crosses

the blood–brain barrier
that separates the
bloodstream from the
interior of the brain.
Once in the brain, the
principal mode of action
is as a nonselective
antagonist of adenosine
receptors. The caffeine molecule is structurally similar to
adenosine, and binds to adenosine receptors on the surface of
cells without activating them (an "antagonist" mechanism of
action). Therefore, caffeine acts as a competitive inhibitor.

Instead of slowing down because of the adenosine's effect, the

nerve cells speed up. Caffeine also causes the brain's blood
vessels to constrict, because it blocks adenosine's ability to open
them up. This effect is why some headache medicines like
Anacin contain caffeine -- if you have a vascular headache, the
caffeine will close down the blood vessels and relieve it.
So, now you have increased neuron firing in the brain. The
pituitary gland sees all of this activity and thinks some sort of
emergency must be occurring, so it releases hormones that tell
the adrenal glands to produce adrenaline (epinephrine).
Adrenaline is the "fight or flight" hormone, and it has a number
of effects on your body:

• Your pupils dilate.

• Your breathing tubes open up (this is why people suffering
from severe asthma attacks are sometimes injected with
epinephrine).
• Your heart beats faster.
• Blood vessels on the surface constrict to slow blood flow
from cuts and also to increase blood flow to muscles.
• Blood pressure rises.
• Blood flow to the stomach slows.
• The liver releases sugar into the bloodstream for extra
energy.
• Muscles tighten up, ready for action.

This explains why, after consuming a big cup of coffee, your

hands get cold, your muscles tense up, you feel excited and you
can feel your heart beat increasing.

Caffeine and Dopamine

Caffeine also increases dopamine levels in the same way that

amphetamines do. Dopamine is a neurotransmitter that
activates pleasure centres in certain parts of the brain. Heroin
and cocaine also manipulate dopamine levels by slowing down
the rate of dopamine reabsorption. Obviously, caffeine's effect is
much lower than heroin's, but it is the same mechanism. It is
suspected that the dopamine connection contributes to caffeine
addiction.

You can see why your body might like caffeine in the short term,
especially if you are low on sleep and need to remain active.
Caffeine blocks adenosine reception so you feel alert. It injects
adrenaline into the system to give you a boost. And it
manipulates dopamine production to make you feel good.

The problem with caffeine is the longer-term effects, which tend

to spiral. For example, once the adrenaline wears off, you face
fatigue and depression. So what are you going to do? You
consume more caffeine to get the adrenaline going again. As
you might imagine, having your body in a state of emergency all
day long isn't very healthy, and it also makes you jumpy and
irritable.

The most important

long-term problem
is the effect that
caffeine has on
sleep. Adenosine
reception is
important to sleep,
and especially to
deep sleep. The
half-life of caffeine
in your body is
about six hours.
That means that if
you consume a big
cup of coffee with
200 mg of caffeine
in it at 3:00 p.m., by
9:00 p.m. about 100
mg of that caffeine
is still in your system. You may be able to fall asleep, but your
body will probably miss out on the benefits of deep sleep. That
deficit adds up fast. The next day you feel worse, so you need
caffeine as soon as you get out of bed. The cycle continues day
after day.

Once you get in the cycle, you have to keep consuming the
drug. Even worse, if you try to stop consuming caffeine, you get
very tired and depressed, and you get a terrible, splitting
headache as blood vessels in the brain dilate. These negative
effects force you to run back to caffeine even if you want to
stop.

Tolerance and withdrawal

Because caffeine is primarily an antagonist of the central

nervous system's receptors for the neurotransmitter adenosine,
the bodies of individuals that regularly consume caffeine adapt
to the continuous presence of the drug by substantially
increasing the number of adenosine receptors in the central
nervous system. First, the stimulatory effects of caffeine are
substantially reduced, a phenomenon known as a tolerance
adaptation. Second, because these adaptive responses to
caffeine make individuals much more sensitive to adenosine, a
reduction in caffeine intake will effectively increase the normal
physiological effects of adenosine, resulting in unwelcome
withdrawal symptoms in tolerant users. Caffeine tolerance
develops very quickly, especially among heavy coffee and
energy drink consumers. A reduction in serotonin levels when
caffeine use is stopped can cause anxiety, irritability, inability to
concentrate, and diminished motivation to initiate or to complete
daily tasks; in extreme cases it may cause mild depression.
Together, these effects have come to be known as a "crash".

Careful research conducted by the department of psychiatry and

behavioural sciences at Johns Hopkins University School of
Medicine shows that low to moderate caffeine intake (as little as
one 14-ounce mug per day) can quickly produce withdrawal
symptoms.

Withdrawal symptoms — possibly including headache, irritability,

an inability to concentrate, drowsiness, insomnia and pain in the
stomach, upper body, and joints may appear within 12 hours
after discontinuation of caffeine intake, peak at roughly 48
hours, and usually last from one to five days, representing the
time required for the number of adenosine receptors in the brain
to revert to "normal" levels, uninfluenced by caffeine
consumption.

Caffeine Intoxication and Overdose

An acute overdose
of caffeine usually
in excess of about
250 mg,
dependent on
body weight and
level of caffeine
tolerance, can
result in a state of
central nervous
system over-
stimulation called
caffeine
intoxication (DSM-
IV 305.90), or
colloquially the
"caffeine jitters". It
may include
restlessness,
fidgetiness,
nervousness,
excitement, euphoria, insomnia, flushing of the face, increased
urination, gastrointestinal disturbance, muscle twitching, a
rambling flow of thought and speech, irritability, irregular or
rapid heart beat, and psychomotor agitation. In cases of much
larger overdoses, mania, depression, lapses in judgment,
disorientation, disinhibition, delusions, hallucinations, and
psychosis may occur, and rhabdomyolysis (breakdown of
skeletal muscle tissue) can be provoked.

These symptoms can cause significant social and occupational

disturbances. Caffeine intoxication is rarely fatal, although
5,000-10,000 mg of caffeine can actually kill you. Fortunately,
most people won’t ever ingest this much caffeine accidentally -
it would take between 30 and 60 cups of coffee in one morning.

Overuse

In large amounts, and especially over extended periods of time,

caffeine can lead to a condition known as Caffeinism.
Caffeinism usually combines caffeine dependency with a wide
range of unpleasant physical and mental conditions including
nervousness, irritability, anxiety, tremulousness, muscle
twitching (hyper-reflexia), insomnia, headaches, respiratory
alkalosis, and heart palpitations. Furthermore, because caffeine
increases the production of stomach acid, high usage over time
can lead to peptic ulcers, erosive esophagitis, and
gastroesophageal reflux disease. Caffeine may also increase the
toxicity of certain other drugs, such as paracetamol.

There are four caffeine-induced psychiatric disorders recognized

by the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition: caffeine intoxication, caffeine-induced anxiety
disorder, caffeine-induced sleep disorder, and caffeine-related
disorder not otherwise specified (NOS).

Caffeine-induced sleep disorder

Caffeine-induced sleep disorder is a psychiatric disorder that

results from overconsumption of the stimulant caffeine. The
specific criteria for this disorder in the fourth axis of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
include that there must be a significant inability to sleep which is
caused entirely by the physiological effects of caffeine as proven
by an examination; if sleeping issues can be accounted for due
to a breathing-related sleep disorder, narcolepsy, or another
mental disorder, then caffeine-induced sleep disorder is not the
cause. This condition causes a notable impairment in functioning
in sufferers

Although the number of symptoms due to caffeine consumption

are many, however on the basis of importance, severity and
relation to working habits of the BPO employees we have
selected- Sleep Disturbances, Headache & Irritability.
 REVIEW OF LITERATURE
Although a number of studies on caffeine addiction have been
conducted in the past, the following two appeared to be
significant with respect to our study.

The first study done by the University of the Philippines (UP)

Population Institute is about prevalence of caffeine consumption
among BPO workers. The study, entitled Lifestyle and
Reproductive Health Issues of Young Professionals in Metro
Manila and Metro Cebu (), focused on the profile and lifestyle of
young workers in the call center and non-call center industries in
Metro Manila and Metro Cebu. The results obtained were:
○ Highly-caffeinated drinks like coffee and tea are a staple of
BPO workers diets, which are provided by management
through establishment of Vendor machines, free of cost.
○ In all, 2/3 of young workers drink coffee daily, but call center
workers drink more coffee that their non-call center
counterparts (2.3 cups a day for call center workers vs 1.7
cups for the latter).
○ More call center workers also consume tea (1/4 of
respondents), compared to non-call center workers (only 1/5).
○ The study also revealed that half of young workers drink soda
daily, at an average of 1.5 bottles/cans a day, regardless of
group.
○ However, energy drinks are not as popular: only 15% of
young workers drink energy drinks daily, the study found out.

The second was a study conducted by American Academy of

Pediatrics (Charles P. Pollak, 2003) to study the Caffeine
consumption and its effect on sleep patterns in teenagers. A
total of 191 students participated. Caffeine intake ranged
between 0 and 800 mg/d. Mean use over 2 weeks ranged up to
379.4 mg/d and averaged 62.7 mg/d. According to the study,
higher caffeine intake in general was associated with shorter
nocturnal sleep duration, increased wake time after sleep onset,
and increased daytime sleep. Regardless of whether caffeine use
disturbed sleep or was consumed to counteract the daytime
effect of interrupted sleep, caffeinated beverages had
detectable pharmacologic effects.
 RESEARCH QUESTION

“Will a cross-sectional study on 100 BPO

workers of age group 20-50 yrs to detect
the effects of caffeine addiction show
any relationship between altered working
habits and excess caffeine consumption
as assessed by questionnaire method? ”
 OBJECTIVES

• To find the prevalence of caffeine

consumption among BPO employees.

• To assess the proportion of BPO

employees experiencing headache,
irritability and sleep related
symptoms.

• To explore the relationship between

the above mentioned symptoms and
excess caffeine consumption.

• To give recommendations to BPO

employees based on the observations
of the study.
 MATERIALS & METHODS

Design of study Cross-sectional study

Subjects Randomly selected Sample of 100 BPO

Employees 20 to 50 years old and working at
BPO firms-Telecommunication and First
Source

Inclusion Criteria All BPO workers in the age group 20-50 yrs

Exclusion Criteria BPO employees older than 50 yrs

BPO employees working at BPO firms other

than Telecommunication and First Source

Sampling Simple Random Sampling

Technique
Study Tool Pre-determined Semi-structured
Questionnaire

Study Area Indore

Require Availabl
Cost
d e

Manpower Volunteers 4 4 Nil

Questionnai
Material 100 100 Rs. 150
re
Incidental
Rs. 50
Charges

IMPLEMENTATION

The entire research study was done on 2 BPO firms in Indore-

Telecommunications and First Source. A Qualitative protocol
was used which involved data collection through a detailed
objective-questionnaire. The questionnaire was distributed in
random manner through the HR manager of the firms to BPO
workers. Due to the concerns of the HR about compromise of
their office time, they were given 2 days to fill the
questionnaires.
The Instrument for data collection, in the form of a ‘Structured
Questionnaire’, consisted of the following sections:
1. Demographic aspects included name, age, gender, working
hours and Alcoholic & Smoking nature.
2. Caffeine Consumption was assessed by objective questions
about choice of beverage, size of cup and interval between
drinks. (Q1-5)
3. Sleep disturbance suspected to be caused due to caffeine
was assessed mainly by subject’s perception of his quality of
sleep along with the duration of sleep. (Q6-10)
4. Headache problems were asked directly. (Q11)
5. Irritability as a part of the mood disorders suspected to be
caused by Caffeine was assessed by 8 part questionnaire
modified and adopted from The Irritability Questionnaire by
K.J. Craig et al. 2008 (Kevin J. Craig, 2008). (Q12)

A copy of Questionnaire is given in the Appendix.

The responses thus obtained were then compiled, processed and

analysed to arrive at the opinions on various issues.
 SCORING CRITERIA
As already mentioned the questions were divided in four
sections. Most questions had three responses. Maximum points
were allotted to exaggerated responses and associations,
whereas minimum points were allotted to responses depicting
least degree of association. The score of each section was then
added to attain the total score.

RESPONSE SCORE

1. Which beverage you take often?

a Tea 1

b Coffee 2

c Energy Drinks 3

d De-Caffeinated Beverages 0

2. How often do you drink?

a Never 1

b Often 2

c Daily 3

3. How many cups you drink/day?

a 1-2 1

b 3-5 2

c >5 3

4. Which cup do you prefer?

a Disposable Tea Cup 1

b Regular Coffee Mug 3

 c Other 2

5. Usual interval between 2 beverages?

a ½-2 hr 3

b 4-6 hrs 2

c >12 hrs 1

6. How much do you usually sleep in a day?

a 4-6 hrs 3

b 6-8 hrs 2

c 8-10 hrs 1

7. Do you have trouble sleeping at night?

a Yes 3

b No 0

8. Do you feel sleepy all the day?

a Yes 3

b No 0

9. The amount of time that you usually take to

fall asleep is:
a < 15 mins 1

b 15 mins – 1 hr 2

C > 1 hr 3

10 After taking a nap you usually feel-

.
a Refreshed 0

b Sleepy 3
11 How often do you have a headache?
.
a Daily 2

b Once every 3-4 days 1

c Rarely 0

Total score for Caffeine Consumption (Q1-5)

1-6 Mild intake
7-10 Moderate intake
11-15 Heavy intake
OBSERVATIONS & INTERPRETATION
 INITIAL RESEARCH FINDINGS

○ Out of the total 100 respondents 71% were male and 29% were
female.
○ All of the subjects worked in Day Shifts.
○ Most of the subjects fall in the range of age 20-25 yrs.
1. Which beverage you take often…

Table 1 – Choice of Beverage

Choice of Beverage Percentage (%)

Tea 61

Coffee 34

Energy Drinks 5

De-Caffeinated Beverages 0

Grand Total 100

Most of the respondents selected Tea as their drink of choice,

followed by Coffee, whereas none opted for De-Caffeinated
Beverages. This indicates a need to create awareness amongst
the BPO employees about the benefits of switching to De-
Caffeinated Beverages (like Decaf Coffee).

Tea- 61%, Coffee- 34%, Energy Drink- 5%, De-Caffeinated- 0%

2. How often do you drink…

Table 2 – Frequency of Beverage Consumption

Frequency of Beverage Percentage (%)
Consumption

Never 10

Often 29

Daily 61

Grand Total 100

As the above table shows, 61% of the subjects consume a

caffeine containing beverages on a daily basis.

Never- 10%, Often- 29%, Daily- 61%

3. How much cups you drink/day…

Table 3 – Number of cups consumed per day

Cups consumed per day Percentage (%)

1-2 49

3–5 27

>5 24

Grand Total 100

The responses show that only about a fourth of the subjects

drink more than 5 cups a day, or in other word are dependent on
caffeine. While half of the subjects have only an ordinary intake
of upto 2 cups per day.

1-2 cups- 49%, 3-5 cups- 27%, >5 cups- 24%

4. Which cup do you prefer…

Table 4 – Type of Cup preferred

Preference of Cup Percentage (%)

Disposable Tea Cup 58

Regular Coffee Mug 34

Other 8

Grand Total 100

Since majority of the respondents have selected Tea as their

choice of beverage, so it’s understandable that 58% chose
Disposable Tea Cup as their option.

Disposable Tea Cup- 58%, Regular Coffee Mug- 34%, Other- 8%

5. Usual interval between 2 beverages…

Table 5 – Interval between consumption of Beverages

Interval between 2 beverages Percentage (%)

½ - 2 hrs 27

4 - 6 hrs 54

> 12 hrs 19

Grand Total 100

More than 50% of the subjects consume the beverage at an avg.

interval of 4-6 hrs. However, 27% drink a Caffeine containing
beverage more frequently at an interval of ½ to 2 hrs.

½-2hrs- 27%, 4-6 hrs- 54%, >12 hrs- 19%

6. How much do you usually sleep in a
day…

Table 6 – Duration of Sleep

Duration of Sleep Percentage (%)

4 - 6 hrs 14

6 - 8 hrs 63

8 - 10 hrs 23

Grand Total 100

63% of the respondents sleep for a normal duration of 6-8 hrs.

Only 14% were found to have reduced amount of sleep.

4-6 hrs- 14%, 6-8 hrs- 63%, 8-10 hrs- 23%

7. Do you have trouble sleeping at night…

Table 7 – Percentage of people having trouble sleeping at night

Trouble sleeping at night Percentage (%)

Yes 52

No 48

Grand Total 100

More than half of the BPO employees have reported they have
trouble sleeping at night, which may be due their caffeine
consumption in addition to other factors.

Yes- 52%, No- 48%

8. Do you feel sleepy all the day…

Table 8 – Percentage of people feeling sleepy all day

Sleepy all Day Percentage (%)

Yes 55

No 45

Grand Total 100

Despite the fact all of the BPO employees were day-shift workers
and majority having an adequate sleep, more than half of them
feel sleepy all day.

Yes- 55%, No- 45%

9. The amount of time that you usually
take to fall asleep is…

Table 9 – Time taken to fall asleep

Time taken to fall asleep Percentage (%)

0 – 15 mins 13

15 mins – 1 hr 83

> 1 hr 4

Grand Total 100

Maximum of the respondents require a considerable time of upto

1 hr to fall asleep. Only 4 respondents out of 100 take even
longer than 1 hr to fall asleep.

0-15 mins- 13%, 15 mins-1hr- 83%, > 1hr- 4%

10. After taking a nap you usually feel…

Table 10 – Proportion of people who

Percentage (%)

Refreshed 63

Sleepy 37

Grand Total 100

Around 1/3rd of the subjects feel sleepy upon waking up.

Refreshed- 63%, Sleepy-37%

11. How often do you have a headache…

Table 11 – Frequency of Headache

Frequency of Headache Percentage (%)

Daily 23

Once every 3-4 days 37

Rarely 40

Grand Total 100

1 out of 4 respondents experience headache on a daily basis,

which indicates the need to change the working conditions of the
BPO employees.

Daily- 23%, Once every 3-4 days- 37%, Rarely- 40%

 Prevalence of Caffeine
Consumption

Caffeine Consumption Percentage (%)

I - Mild intake 8

II - Moderate intake 57

III - Heavy intake 35

Grand Total 100

EVALUATION & ANALYSIS

According to this study about 1/3rd of BPO employees were
heavy consumers of Caffeine, and more than 50% fall in the
category of moderate intake. However, this may not represent
the overall trends due to limitation of sample size.

Mild intake- 8%, Moderate intake- 57%, Heavy intake- 35%

 Sleep Disturbance
Kruskal-Wallis Test
Caffeine Consumption N Mean Rank
I - Mild intake 8 35.56

II - Moderate intake 57 44.20

III - Heavy intake 35 64.17

Total 10
0
Calculated χ2 = 12.724, Df= 2
Table χ2 = 10.60 (For 95% confidence interval)

Since the calculated χ2 is more than Table value so the Null

Hypothesis is rejected and Alternate Hypothesis is accepted.

According to Spearman’s rho, correlation coefficient, r= 0.403

This means that around 16% of prevalence of Sleep Disturbance
amongst BPO employees may be due to Caffeine consumption.
 Headache
Caffeine Consumption Total

Headache I - Mild II - III - Heavy

intake Moderate intake
intake

Rarely 4 29 7 40

Occasionally 3 15 19 37

Daily 1 13 9 23

Total 8 57 35 GT = 100
Pearson’s χ2 = 10.468, P value = 0.033

According to the above table, frequency of daily headache

increases with increasing intake of Caffeine. From 12.5% in
Group I to 22.8% in Group II to 25.7% in Group III experience
headache on a daily basis.

Also total subjects complaining of headache rose significantly

from 50% among workers with Moderate intake to 80% among
those with Heavy intake.
 Irritability
Kruskal-Wallis Test
Caffeine N Mean Rank
Consumption
I - Mild intake 8 20.25

II - Moderate intake 57 40.05

III - Heavy intake 35 74.43

Total 100
Calculated χ2 = 39.958, Df= 2
Table χ2 = 10.60 (For 95% confidence interval)

Since the calculated χ2 is more than Table value so the Null

Hypothesis is rejected and Alternate Hypothesis is accepted.

According to Spearman’s rho, correlation coefficient, r= 0.720

This means that about 50% of prevalence of Irritability amongst
BPO employees may be due to Caffeine consumption.
 CONCLUSION
• More than 50% of the BPO employees were
found to have moderate intake of Caffeine.
And as many as 35% were heavy consumers
of Caffeine.

• 61% of subjects are habituated to drink a

Caffeine containing beverage daily.

• According to this study 16% of prevalence of

Sleep disturbance, 50% of Irritability may be
attributed to high Caffeine consumption.

• Also Heavy consumers of Caffeine were found

to have significantly more complaints (80%) of
headache as compared to Mild consumers
(50%).
 DISCUSSION
Caffeine is the most commonly consumed psychoactive drug in
the world. It produces tolerance very quickly which is responsible
for its various withdrawal symptoms. Out of various side-effects
of Caffeine we have selected to study- Sleep disturbances,
headache and Irritability.

The aim of our study was to find out the overall prevalence of
caffeine consumption, and to explore the relationship between
excess caffeine consumption and the above mentioned
symptoms.

It was a cross sectional study done in a randomly selected

sample of 100 BPO employees 20 to 50 years old working at
Telecommunications & First Source, Indore. Data was collected
via a semi-structured questionnaire which was then compiled
and analyzed.

According to the study 57% of the BPO employees were found to

have moderate intake of Caffeine and as many as 35% were
heavy consumers. This might be ascribed to free vending
machines provided by the management. Also in the study we
were able to correlate Sleep Disturbance (16%), Irritability (50%)
with Caffeine consumption. 80% of Heavy consumers were found
to have complaints of Headache as compared to 50% of Mild
consumers.

In comparison to a previous study- “Lifestyle and Reproductive

Health Issues of Young Professionals in Metro Manila and Metro
Cebu” conducted by the University of the Philippines (UP)
Population Institute which stated that 2/3rd of BPO employees
consumed Caffeine containing beverage on a daily basis, our
results of 61% correlate well, considering the demographic and
geographic limitations.
 RECOMMENDATIONS

• The BPO workers and all who have moderate to

heavy intake should be made aware of the ill-effects
of long term caffeine consumption.

• DRINK LOTS OF WATER, LOTS AND LOTS OF WATER.

Get yourself a replacement drink, it could be water,
juice, decaf - just something to get when the urge
for a cup sneaks in.

• Herbal Tea can also be used a good alternative to

Caffeine containing beverages.

• Workers should avoid drinking Caffeine beverage at

least 4hrs prior to sleeping, and get adequate sleep
of 6-8 hrs.

• They should indulge in relaxation activities such as

Meditation, Exercise.

• The BPO management should have provisions for

De-Caffeinated beverages, which will improve the
working capacity of their employees along with a
healthy life style.
 BIBLIOGRAPHY
1. http://www.abs-cbnnews.com/lifestyle/08/05/10/call-center-
workers-diet-fast-food-caffeine-and-alcohol. [Online]

2. Charles P. Pollak, David Bright. Caffeine Consumption and

Weekly Sleep Patterns in US Seventh-, Eighth-, and Ninth-
Graders. Pediatrics. 2003, 111.1.42.

3. Kevin J. Craig, Heidi Hietanen, Ivana S. Markova,

German E. Berrios. The Irritability Questionnaire: A new scale
for the. Psychiatry Research. 2008, 367–375.

4. Park, K. Park's textbook of Preventive and Social Medicine.

5. http://health.howstuffworks.com/wellness/drugs-
alcohol/caffeine.htm. [Online]

6. www.medterms.com. [Online]

7. http://en.wikipedia.org/wiki/Caffeine. [Online]

8. http://coffeeaddic.blogspot.com/. [Online]
APPENDIX
 Appendix I

Time Line Chart

 Appendix II

Department of Community Medicine

MGM Medical College & MY Hospital Indore
PSBH Questionnaire

Name- Age: ___ yrs Sex:

M/F

Working hours- Day Shift/Night Shift

Alcoholic/Non-Alcoholic Smoking/Non-Smoking

1. Which beverage you take often?

Tea Coffee Energy drinks De-Caffeinated

Beverages

2. How often do you drink?

Never Often Daily

3. How much cups you drink/day?

1-2 3-5 >5

4. Which cup do you prefer?

Disposable Tea Cup Regular Coffee Mug Other-

_________________

5. Usual interval between 2 beverages?

½-2 hr 4-6 hrs >12 hrs

6. How much do you usually sleep in a day?

4-6 hrs 6-8 hrs 8-10 hrs

7. Do you have trouble sleeping at night? Yes/No

8. Do you feel sleepy all the day? Yes/No
9. The amount of time that you usually take to fall asleep is: ________
10.After taking a nap you usually feel-
 Refreshed Sleepy

11.How often do you have a headache?

Daily Once every 3-4 days Rarely

12. The following statements are about feelings that everyone experiences
from time to time. Please circle the number that best shows how you have
been feeling over the last 2 weeks. Don't take too long with your answers.
Your immediate response is probably the most accurate.
• I become impatient easily when I feel under pressure.
How often? How much?
0 – Never 0 – Not at all
1 – Occasionally 1 – A little
2 – Quite often 2 – Moderately
3 – Most of the time 3 – Very much so
• At times I find everyday noises irksome.
How often? How much?
0 – Never 0 – Not at all
1 – Occasionally 1 – A little
2 – Quite often 2 – Moderately
3 – Most of the time 3 – Very much so
• At times I can’t bear to be around people.
How often? How much?
0 – Never 0 – Not at all
1 – Occasionally 1 – A little
2 – Quite often 2 – Moderately
3 – Most of the time 3 – Very much so
• When I get angry, I use bad language or swear.
How often? How much?
0 – Never 0 – Not at all
1 – Occasionally 1 – A little
2 – Quite often 2 – Moderately
3 – Most of the time 3 – Very much so
• Things are not going according to the plan at the moment.
How often? How much?
0 – Never 0 – Not at all
1 – Occasionally 1 – A little
2 – Quite often 2 – Moderately
3 – Most of the time 3 – Very much so
• I am quiet sensitive to others remarks.
How often? How much?
0 – Never 0 – Not at all
1 – Occasionally 1 – A little
2 – Quite often 2 – Moderately
3 – Most of the time 3 – Very much so
• I feel as if people make my life difficult on purpose.
How often? How much?
0 – Never 0 – Not at all
1 – Occasionally 1 – A little
2 – Quite often 2 – Moderately
3 – Most of the time 3 – Very much so
• Other people always seem to be getting the breaks.
How often? How much?
0 – Never 0 – Not at all
1 – Occasionally 1 – A little
2 – Quite often 2 – Moderately
3 – Most of the time 3 – Very much so
 Appendix III

Master Table
Age(y Q Q Q Q Q Q Q Q Q Q1 Q1
Names rs) Sex 1 2 3 4 5 6 7 8 9 0 1 Q12
Aashiq Ali 28 M a c b a b a a a b b a 40
Abijeet Singh 30 M a b c a b b a a b b b 33
Abishek
Nageshwar 21 M b c c b a b a a b b c 41
Ajay 25 M c c c a a b a a b b b 43
Akansha
Dawar 20 F c c a a c c b b c a a 18
Akida Wahi 20 F b b a a c b b b a a c 11
Alka 22 F b c a b b a b b b a b 28
Altaf Khan 22 M b b c a b c b a a a a 11
Anil Bbhosle 25 M b a c b b b a a b a b 23
Anil Maurya 22 M a b a a c c b a b b b 9
Anish Tripathi 25 M a a a a b a b a c a b 21
Ankit Khourke 21 M a c a c b a b a b a a 23
Anshul Kumar 25 M a c c a b c b a b a a 34
Anuj Gupta 20 M a c a a c c b b b a c 6
Anurag
Mohan 22 M c b b b b c a a b b b 34
Arjun Verma 25 M a c a c a b a a b b a 33
Arpit Navlikha 21 M b b a a b b b b b a c 16
Ashok Khare 22 M b b b b b b a b b b c 37
Bharat Kumar 45 M a c b a b b b a b a c 10
Bijendra
Jaiswal 28 M b c c a b b a a b b b 42
Birbal Singh 30 M a c b b b b b b b a b 34
Brijesh
Chaurasia 21 M a c b b b b b a b a a 23
Chagan Lal 50 M a c a a b a a a b a b 26
Chanchal
Singh 23 F a b b a a b a b b a a 21
Chandni
Likhar 20 F b b a b a b b b b a c 21
Debashish 25 M a b a a c c b b b a c 13
Deepak
Bhavsar 22 M a b b b b c b a b a c 18
Devendra
Bhayal 20 M b b b b b a a b b b b 39
Dinesh 22 M a c a b b b a b b a a 21
Fatema
Collegewala 20 F a c a a b c b a b a c 12
Gaurav Gupta 23 M a b b a c b b a b a b 13
Gokul kumar 23 M b a c a a a a a b a b 24
Gopal
Rathore 22 M a c a a c c b a c b c 7
Jayshree 20 F b b a c a b b b a a c 17
Jitendra 20 M a b a b b b b a b b b 20
Kamlesh
Wadhwani 21 M a c b b b b b a b b a 33
Karan Kumar 30 M a c c a a b a a b b b 42
Karan Trivedi 24 M b c a c c c b b b a c 8
Keerthi 21 F a b a a c c a b b b c 12
Kratika Joshi 22 F b c b b b b a b b b a 33
Laxmi bai 50 F a c b a b b a b b b b 24
Mahesh
Rathore 24 M a c c a a b a a b b b 43
Manish 20 M a c a a c b a a b a c 19
Manisha
Goyal 20 F a c a a c c a a b a c 12
Mazhar Ali 22 M a c c a a b a a b b b 36
Monica
Verma 24 F a c a c b b b a b a b 22
Muffadal
Bhojawala 24 M b c b b b a a b a a c 32
Mulayam
Singh 36 M a c b a a a a a b b a 27
Munish
Nandwani 27 M b a a b b b b b a a c 11
Murtaza Johar 20 M a b b a b b b a b a b 30
Muskan Jain 22 F b c b a b a a b a a c 44
Naman
Srrivastava 25 M b c c c a b a a b b b 44
Natasha Shah 25 F c c b b a b b b b a a 33
Naveen
Jaiswal 31 M a c c a b c a b b a a 29
Neelam Bajaj 21 F a c a b c b a b b a c 20
Neeraj K 35 M b b a a b b b b b a c 26
Nilesh 22 M a a c a c c a a b b b 20
Nitesh 23 M a c a a a b a a b a b 20
Nishant Rai 23 M b c b a b a a b b b b 31
Palak Dave 22 M a c b a b c a a b a c 12
Parul Shah 31 F a b b a b c b b b a b 28
Pawan
Rathore 24 M a c b a b b a a b a a 17
Pawan Sahu 22 M a c c a a b a a b b b 40
Pinky Verma 21 F a c a b b a a b b a c 31
Prashant
Choudhary 25 M b b b a b b b b a a c 33
Preeti 21 F a c c b a c b a a a a 32
Preeti Singh 27 F b b b b b b b a b b b 28
Radhe Shyam 47 M a c a a b b b b b a c 28
Rahul Medla 21 M a b b c a b a a b a c 21
Rahul Tare 31 M a a a a a b b b a b c 16
Rajendra
Verma 33 M a c a b b b a b b a b 26
Rajesh Verma 25 M b c c b b b a a b b b 38
Rakesh
Verma 24 M a a a a c c b a a b b 8
Ram Singh 25 M a b a a c b b b b a c 11
Ram Kumar 32 M a c b b b b b a b a a 26
Ram Kumar
Gehlot 30 M b c c a b b a a b b a 37
Ranjana
Beeghal 23 F b c a b a b b b b a c 21
Rashmi 20 F b a a a b b b b c a c 16
Richya Vyas 20 F b c a a c c b a b a c 14
Rishika 23 F a c a a a b b b b a b 20
Sanju 22 M a c a a a c b b b a c 23
Shagun
Sharma 24 M b c c a a b a b b b c 48
Shankar
Rathore 30 M a c c a b b a a b b a 34
Shivam
Rathore 25 M b c c b b b a a b b b 42
Shraddha
Prapanna 21 F a a a b a b b b a a a 17
Sneha 23 F b b a a b b b b a a c 13
Sonal Patil 20 F a c a c c b b b b a c 21
Shubham 20 F b b a b b b a a b b b 22
Surbhi
Khatwa 20 F a c a a b c b a b a c 12
Sumit Yadav 21 M c c a b c b a a b b c 19
Swati Sharma 21 F a b a a c b a a b a a 30
Upendra
Ranjan 28 M a b a a b a b b b a c 12
Vijay Prakash 28 M a a a a b b b b b a c 9
Vijay Gujral 25 M a c c a a b a a b b b 38
Vikas Soni 25 M b b a b a b a b a a a 31
Vinay Patodia 21 M a c a b b b a b b a c 31
Vinod Gupta 28 M a c c a a b a a b b b 36
Vinod Jaiswal 25 M b b a b b b a a b a a 17
Yash
Bhrammabha
tt 22 M b c c b a a a a b b b 44
Yogesh
Sharma 29 M a c b b b c a b b a b 35